National Heart & Lung Institute, Imperial College London, London, UK.
Expert Rev Clin Immunol. 2022 Apr;18(4):363-376. doi: 10.1080/1744666X.2022.2053675. Epub 2022 Mar 16.
Oral immunotherapy (OIT) is effective at inducing desensitization in food-allergic individuals, and is a valid therapeutic option for those allergic to peanut, cow's milk and egg. However, there is a high rate of dose-related adverse events, and at least one fatality to OIT has been reported.
We provide an update on the broader framework of issues which will impact on the availability and uptake of OIT.
The need for standardized products remains controversial. A licensed product exists for peanut-OIT, but OIT can also be safely achieved using peanut-containing foods at much lower cost. For other allergens, OIT can only be done with non-pharma products - something which has been done safely for over 2 decades. There is a need to develop personalized protocols for OIT, particularly for the 20% of patients unable to tolerate standard OIT. Cost-effectiveness is dependent on improved quality of life, but evidence for this is currently lacking, and is a key evidence gap. OIT is likely to be cost-effective, particularly if noncommercial products are used. There may be a trade-off: in patients with lower reaction thresholds, a commercial product may be needed for initial updosing, until a level of desensitization is achieved when they can be switched to natural food products.
口服免疫疗法（OIT）可有效诱导食物过敏个体脱敏，是花生、牛奶和鸡蛋过敏患者的有效治疗选择。然而，OIT 存在较高的剂量相关不良事件发生率，且至少有一例 OIT 相关死亡报告。
我们提供了更广泛的问题框架更新，这些问题将影响 OIT 的可及性和采用。
标准化产品的需求仍存在争议。已有用于花生-OIT 的许可产品，但使用含花生的食物也可以安全地进行 OIT，成本要低得多。对于其他过敏原，OIT 只能使用非药物产品，这已经安全实施了 20 多年。需要为 OIT 制定个性化方案，特别是对于 20%无法耐受标准 OIT 的患者。成本效益取决于生活质量的改善，但目前缺乏这方面的证据，这是一个关键的证据空白。OIT 可能具有成本效益，特别是如果使用非商业产品。可能需要权衡利弊：对于反应阈值较低的患者，在达到脱敏水平之前，可能需要使用商业产品进行初始增量给药，然后可以切换到天然食品。
